Retransplantation of the liver for recurrent hepatitis B virus infection: The Paul Brousse experience

Recurrent hepatitis B virus (HBV) infection of the liver graft is character ized by a severe outcome and high level of HBV replication. For many invest igators, retransplantation appears contraindicated because of constant recu rrence and a high mortality. We report our experience in this setting. Betw een January 1985 and December 1995, 10 patients who underwent retransplanta tion for HBV graft reinfection were studied. According to the antiviral tre atment administered after HBV recurrence on the first liver graft and the p rotocol of antiviral prophylaxis after retransplantation, two groups were d efined: group 1 underwent retransplantation before January 1992 (n = 5), an d group 2 underwent retransplantation after January 1992 (n = 5). At the ti me of reinfection, serum HBV DNA was positive in all patients, hepatitis Be antigen (HBeAg) was positive in 6 patients. Antiviral therapy was administ ered to 7 patients (group 1, adenine arabinoside mono phosphate [ara-Amp; n = 3]; group 2, ara-Amp [0 = 5], ganciclovir [n = 4]). After retransplantat ion, long-term antibody to HE surface antigen (anti-HBs) immunoglobulins we re administered to achieve an anti-HBs titer greater than 100 IU/L in group 1 and to achieve an anti-HBs titer greater than 500 IU/L associated with p rophylactic intravenous ganciclovir administration (5 mg/kg three times wee kly) for 2 years in group 2. In group 1, all patients died, either perioper atively or secondary to HBV recurrence (1 year survival, 0%). In group 2, 1 patient died 50 months after retransplantation of HBV cirrhosis on the sec ond graft, and 4 patients remained HBsAg negative at a mean of 41 months (r ange, 24 to 68 months) after retransplantation. The prognosis of retranspla ntation for HBV recurrence was dramatically improved by the administration of antiviral therapy before retransplantation and the maintenance of a high anti-HBs level combined with antiviral therapy after retransplantation. Co pyright (C) 1999 by the American Association for the Study of Liver Disease s.